Provider Demographics
NPI:1194926055
Name:BAILON, CHARINA ANDANG (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARINA
Middle Name:ANDANG
Last Name:BAILON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CALLE ORIENTE
Mailing Address - Street 2:APT. 1
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3722
Mailing Address - Country:US
Mailing Address - Phone:408-262-7901
Mailing Address - Fax:
Practice Address - Street 1:30067 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1758
Practice Address - Country:US
Practice Address - Phone:510-475-5717
Practice Address - Fax:510-475-5806
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice